Díaz del Arco C, Estrada Muñoz L, Ortega Medina L, Molina Roldán E, Cerón Nieto MÁ, García Gómez de las Heras S, Fernández Aceñero MJ. Clinicopathological differences, risk factors and prognostic scores for western patients with intestinal and diffuse-type gastric cancer. World J Gastrointest Oncol 2022; 14(6): 1162-1174 [PMID: 35949214 DOI: 10.4251/wjgo.v14.i6.1162]
Corresponding Author of This Article
Cristina Díaz del Arco, MD, Staff Physician, Associate Professor, Department of Surgical Pathology, Hospital Clínico San Carlos, c/ Profesor Martín Lagos s/n, Madrid 28040, Spain. crisdelarco@gmail.com
Research Domain of This Article
Pathology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Jun 15, 2022; 14(6): 1162-1174 Published online Jun 15, 2022. doi: 10.4251/wjgo.v14.i6.1162
Clinicopathological differences, risk factors and prognostic scores for western patients with intestinal and diffuse-type gastric cancer
Cristina Díaz del Arco, Lourdes Estrada Muñoz, Luis Ortega Medina, Elena Molina Roldán, M Ángeles Cerón Nieto, Soledad García Gómez de las Heras, M Jesús Fernández Aceñero
Cristina Díaz del Arco, Luis Ortega Medina, Elena Molina Roldán, M Ángeles Cerón Nieto, M Jesús Fernández Aceñero, Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid 28040, Spain
Cristina Díaz del Arco, Luis Ortega Medina, M Jesús Fernández Aceñero, Department of Legal Medicine, Psychiatry and Pathology, Complutense University of Madrid, Madrid 28040, Spain
Lourdes Estrada Muñoz, Department of Surgical Pathology, Hospital Rey Juan Carlos, Madrid 28933, Spain
Lourdes Estrada Muñoz, Soledad García Gómez de las Heras, Department of Basic Medical Sciences, Rey Juan Carlos University, Madrid 28933, Spain
Author contributions: Díaz del Arco C participated in the data acquisition, analysis, interpretation, manuscript draft, approval and agreement; Estrada Muñoz L participated in the data acquisition, analysis, manuscript revision, approval and agreement; Ortega Medina L participated in the study design, data interpretation, manuscript revision, approval and agreement; Molina Roldán E, Cerón Nieto MA, García Gómez de las Heras S participated in the data acquisition, manuscript revision, approval and agreement; Fernández Aceñero MJ participated in the study design, data analysis and interpretation, manuscript draft, approval and agreement.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Hospital Clínico San Carlos.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: Data will be available on request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cristina Díaz del Arco, MD, Staff Physician, Associate Professor, Department of Surgical Pathology, Hospital Clínico San Carlos, c/ Profesor Martín Lagos s/n, Madrid 28040, Spain. crisdelarco@gmail.com
Received: December 30, 2021 Peer-review started: December 30, 2021 First decision: March 13, 2022 Revised: April 1, 2022 Accepted: May 27, 2022 Article in press: May 27, 2022 Published online: June 15, 2022 Processing time: 161 Days and 15.1 Hours
ARTICLE HIGHLIGHTS
Research background
In the molecular era, the Laurén system is still a cost-effective and widely implemented classification for gastric cancer (GC) and it has been recently associated with clinical, histological and molecular features of these tumors. Laurén subtypes have also shown differences in response to systemic therapy.
Research motivation
Despite recent advances in the understanding of the molecular biology of GC, there is a need to develop new prognostic tools for patient stratification in clinical practice. The implementation of specific scores for patients with intestinal and diffuse-type GC may significantly improve risk assessment and management of GC.
Research objectives
Our aims were to: (1) evaluate the clinicopathological differences between Laurén subtypes; (2) identify specific risk factors for these subtypes; and (3) develop prognostic scores for patients with intestinal and diffuse-type GC.
Research methods
This is a retrospective study of all patients undergoing surgery for GC at a tertiary referral center from 2001 to 2019. Clinical data and gross findings were collected. Histological and immunohistochemical features were assessed by two independent pathologists and prognostic scores were developed based on hazard ratios.
Research results
In our series of western patients with GC, intestinal and diffuse-type tumors showed distinctive epidemiological, clinical and prognostic features. In addition, Laurén subtypes were associated with different risk factors for tumor progression and cancer-specific death. Our prognostic scores for predicting overall survival and disease-free survival in patients with intestinal and diffuse-type GC included clinicopathological variables that can be easily calculated in clinical practice and showed an excellent patient stratification into three (diffuse GC) or four (intestinal GC) prognostic groups.
Research conclusions
The stratification of GC patients depending on Laurén subtypes and the implementation of specific clinicopathological prognostic scores in intestinal and diffuse-type tumors can be useful for patient stratification, risk assessment and treatment selection.
Research perspectives
Our prognostic scores should be externally validated in patients from both western and eastern countries due to the geographical variation of GC. In addition, this study opens a door to the development and implementation of cost-effective and specific clinicopathological prognostic scores in patients with GC in different contexts.
